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Introduction
Sexually transmitted infections (STIs) have detrimental impacts on quality of life and survival and impose a burden on the UK National Health Service (NHS). In 2015, there were 435000 new diagnoses in England with a 20% and 11%increase observed in the incidence of syphilis and gonorrhoea respectively compared with 2014. 1 STI incidence is highest among people under the age of 25, men who have sex with men (MSM) and black ethnic minorities. 1
Condoms can protect against transmission of many STIs including gonorrhoea, chlamydia, syphilis and HIV. 2 The 2014-2015 increase in syphilis and gonorrhoea diagnoses is attributed to high levels of unprotected sex. 1 Reasons condoms are not used or are used incorrectly include cost, lack of knowledge and social norms. Condom distribution programmes (CDPs) aim to overcome these challenges by providing condoms free of charge or at reduced prices, possibly accompanied by training or support, such as the C-card programme (the multicomponent programme most commonly offered to young people in England). 3
The Department of Health referred the topic 'Sexually transmitted infections: condom distribution schemes' to the National Institute for Health and Care Excellence (NICE) to develop public health guidance. 4 NICE considers evidence for effectiveness and cost-effectiveness in developing recommendations. A systematic literature review highlighted a paucity of evidence for the cost-effectiveness of CDPs in the UK. 5 Therefore, we developed an economic model to evaluate the cost-effectiveness of CDPs. This study presents our economic evaluation of CDPs for the general population and for targeted at-risk groups: young people, MSM and black ethnic minorities.
Methods
Population
We based the population on English 2011 census data by gender and 5-year age group. 6 Cohorts of the appropriate age-range and gender were selected to model each of the target groups.
Model
We developed an economic model which estimated 'steady state' STI acquisition and associated cost-effectiveness. The model uses an established Bernoulli process which estimates the number of STIs in a cohort of people 7 and has been used in other economic evaluations, including NICE Public Health guidelines. 8 9 The model predicts the proportion of people acquiring an STI in a given gender-specific and age-specific group (W) as a function of the STI prevalence (v), the proportion of...